How to deal with heel pain?

How many of your friends and family have complained to have been suffering from heel pain, or having a heel spur?

When Meena started feeling pain on the underside of her heel, she had to tiptoe out of her bed in the mornings, as her heel would hurt so badly for the first few minutes. It also hurt equally bad when she tried to get out of her office chair. When she finally had to visit her doctor, she was diagnosed to be suffering from ‘planter fasciitis’.

Heel pain is a common condition in adults that may cause significant discomfort and disability. A variety of soft tissue and bone problems can cause heel pain, but the most common cause in adults is ‘plantar fasciitis.’ Patients with plantar fasciitis report increased heel pain with their first steps in the morning or when they stand up after prolonged sitting.

Planter fasciitis literally means inflammation and swelling of the ‘planter fascia’ which is a tough sheet of band extending from your heel to the base of your toes. This band is responsible for the normal arching of your soles. Interestingly, people with flat feet have very weak band and resultantly rarely have this disease (they still continue to have heel and foot pain from other causes though). All through the day as we walk, run and climb, this band (the planter fascia) undergoes stretching as it tightens and relaxes under our weight.

Because of its fan shaped structure from the heel to the toes, the maximum effect of this tension stress is concentrated at the heel and spread out at the toes. This repetitive stretching, and its pulling at its attachment at the heel bone (the calcaneum), gives rise to swelling. This is worst when during rest the inflamed fascia shrinks, so that the moment you try to put weight on it, it undergoes stretching and causes pain. It is almost like the jarring and creaking of a rusty door hinge as you try to pry it open.

Diagnosis
This disease is unfortunately not as easy to treat as it is to diagnose, mainly because it is impossible to stay off your feet long enough for the fascia to get some rest and heal itself, for say, around a month. Though your X-rays will often show up a small bony outcrop from your heel bone, making you think that ‘there lies the culprit’, this bone is absolutely harmless and is equally frequent among non-sufferers.

The fascia itself cannot be seen in X-rays, & diagnosis is often so straightforward that further investigations and tests are unwarranted. In spite of that, your doctor will invariably ask for X-rays and few lab tests to be done, but that is only to exclude other more ominous diseases of the heel.

Treatment
The mainstay of treatment is relieving pressure, overstretching the fascia, oral anti- inflammatory medications and local steroid injections into the fascia, steroid being a strong anti-inflammatory agent. Pressure relieving starts with wearing soft soled cushioned footwear. This is so important that people wearing adequately cushioned footwear rarely have planter fasciitis. This has to be done all through the day. Walking bare-foot or on hard soles is an absolute no-no. For hard to treat cases, sometimes a night time foot splint is used to keep the fascia stretched while you sleep.

Stretching out the fascia is done by specific stretching exercises, which in itself can shorten the duration of suffering, as also reduce the intensity of pain. Surprised as to why someone would want to stretch out an already stretched out fascia? Actually, the inflammation shrinks the fascia, and stretching it out is our way of making it more pliant. For the same reason, warm saline foot baths are very comforting as they soothe the irritated fascia.

Using anti-inflammatory medication works by reducing local inflammation, but needs to be used for a long time to eliminate the inflammation completely. Local steroid injections act in the same way as oral anti-inflammatory medications – by suppressing inflammation, but are more effective in that it stays concentrated at the site of the disease – and a single injection can work for months. Most people will need two or three injections at monthly or more intervals before the disease is completely eliminated.

Surgery
There however remains a small group of patients who do badly in spite of all modalities, and finally need surgery to release the fascia, but that is no more than five per cent of all affected. The surgery itself is a minor one, and usually patients can walk back home the same day. Think, you can now help Meena to overcome her suffering? You definitely can, by making her wear correct footwear and doing her exercise regularly. But you still need to visit the doctor for correct diagnosis, for there are quite a few other problems which can cause heel pain and mimic planter fasciitis, like calcaneal stress fractures (more likely to occur in athletes who participate in sports that require running & jumping), tarsal tunnel syndrome (heel pain accompanied by tingling, burning, or numbness), and heel pad atrophy (present with diffuse plantar heel pain, especially in patients who are older and obese).

And, if you do not want to go through what Meena is going through, do give due consideration to the labour put in by your planter fascia, and invest in a good soft cushioned shoe.